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GEM - Consulting Skills Advice for the Clinical Observation Tool (COT)

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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It is important to feel comfortable with patient-centred consultations. Often a clinician entering primary care has a great deal of medical knowledge but may consult in a doctor-centred fashion. When starting consulting in primary care it may be helpful to consider some useful phrases that are "open" questions e.g. "can you tell me more about the pain you are experiencing" rather than "closed" questions e.g. "does the chest pain radiate to your arms".

Undertaking consultation skills in a patient centred fashion is important for undertaking COTs (Clinical Observation Tools) and the CSA (Clinical Skills Assessment).

Use of Open Questions during consultations

Open questions are questions that give the patient the opportunity to express his/her views when answering questions. Closed questions lend themselves to the patient responding "yes" or "no".

Some example open questions used in a consultation might be:

  • GP "Good morning Mrs Smith, how can I help you today?"
    • Mrs Smith has a sore throat and says that she has had it for a few days. She has also had a cough.


  • GP "Can you tell me more about your sore throat?" An alternative potential open question in this part of the consultation could be " Can you take me through the details of your problem?"
    • Mrs Smith explains that she has had repeated episodes of sore throats.


  • GP "How is your sore throat affecting you?"
    • Mrs Smith explains that she works as a receptionist in a local company and her sore throat is making her feel unwell whilst she is at work.


  • GP "What is your worry about your sore throat?"
    • an alternative or follow-up question might be "is there anything in particular concerning you about this?" - this allows the patient to make explicit his/her health beliefs and this can be then used within the shared management plan
    • Mrs Smith says that she feels that she needs some antibiotics to resolve her sore throat


  • GP "Yes antibiotics do sometimes help in the treatment of sore throats, do you know how antibiotics work?"
    • Mrs Smith explains that antibiotics "kill the bugs that cause sore throats" and allow you to get better.


  • GP "Yes antibiotics can kill some particular bugs that can cause sore throats called bacteria. Do you know the difference between bacteria and viruses?"
    • Mrs Smith then explains that she does not know the difference


  • GP explains the difference between a virus and a bacterial sore throat. After asking examining the patient and asking more questions, the GP advises Mrs Smith that, based on the history and examination, the sore throat may be related to a bacterial infection. He discusses prescribing an antibiotic via a "delayed prescription". The GP explains that the sore throat is likely to get better anyway but if it is not improving then the antibiotics are likely to lead to a slightly quicker resolution of her symptoms


  • GP ensures that the explanation is understood and accepted by the patient
    • "I don't know whether that makes sense, is there anything you want to ask me?", or "how would you explain your condition to someone else?


  • GP follow-on questions:
    • GP "Do you have any problems with using antibiotics?"
    • GP "Are you happy with this as a plan for managing your sore throat?"

Obviously this summary only highlights some potential open questions that can be used during this particular consultation. These questions will be interspersed with various relevant "closed" questions e.g. are you a smoker? is your throat sore when you swallow? is your weight and appetite normal?

A list of the performance criteria for the Clinical Observation Tool (COT) is linked below.

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The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.


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